Citation Nr: 21070441 Decision Date: 11/24/21 Archive Date: 11/24/21 DOCKET NO. 14-26 978 DATE: November 24, 2021 REMANDED Entitlement to service connection for hypertension, to include as secondary to service-connected disability and/or due to herbicide exposure is remanded. Entitlement to service connection for a urinary disability, to include as secondary to service-connected disability and/or due to herbicide exposure is remanded. Entitlement to service connection for a pancreas disability, to include as secondary to service-connected disability and/or due to herbicide exposure is remanded. Entitlement to service connection for a spleen disability, to include as secondary to service-connected disability and/or due to herbicide exposure is remanded. REASONS FOR REMAND The Veteran had active service from May 1968 to May 1972 with prior service of an unverified nature. The record reflects that the Veteran served in the Republic of Vietnam and that his decorations include the Combat Action Ribbon. The Board notes that this appeal was previously remanded in April 2018. Most recently, in February 2020, and in pertinent part, the Board decided several issues and remanded the remaining issues for evidentiary development. During development, an April 2021 Deferred Rating Decision stated that the issue of entitlement to service connection for hypothyroidism was being deferred due to a change in law adding three new diseases, including hypothyroidism, to the list of conditions that are presumptively associated with exposure to herbicides. It was noted that VA was still implementing this change in law and the issue was to be split from the appeal pending further development by the Agency of Original Jurisdiction (AOJ). The remaining issues, as they have been characterized above, have since been returned to the Board for further consideration. 1. Entitlement to service connection for hypertension, to include as secondary to service-connected disability and/or due to herbicide exposure is remanded. 2. Entitlement to service connection for a urinary disability, to include as to include as secondary to service-connected disability and/or due to herbicide exposure is remanded. 3. Entitlement to service connection for a pancreas disability, to include as secondary to service-connected disability and/or due to herbicide exposure is remanded. 4. Entitlement to service connection for a spleen disability, to include as secondary to service-connected disability and/or due to herbicide exposure is remanded. A review of the record reveals that a remand is necessary to ensure substantial compliance with the Board's February 2020 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Veteran asserts that he suffers from these disabilities as a result of his period of active service, to include exposure to herbicides while on duty in the Republic of Vietnam. The theory of secondary service connection has also been raised by the record. Service connection may be established on a secondary basis for a disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310(a). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) proximately caused by or (b) proximately aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Pursuant to the Board's February 2020 remand, the Veteran received several VA examinations in April 2021. With respect to the Veteran's claimed hypertension, the examiner stated: The Hypertension was caused (in whole or in part) is less likely than not proximately due to or the result service connected disability to specifically include the diabetes. The conditions of Hypertension and service connected disability to specifically include the diabetes are not medically related. The Hypertension is a separate entity entirely from the service connected disability to specifically include the diabetes and unrelated to it. A thorough review of medical literature failed to demonstrate a causal relationship. A nexus has not been established ... There is no evidence of an aggravation Hypertension beyond its natural progression by the service connected disability to specifically include the diabetes. Regarding the urinary disability, the examiner remarked: The Urinary disability was less likely than not incurred in or caused by the disease or injury, events or disease during service. Veteran had no urinary disability condition during service. Records shows urinary condition started post service. A nexus has not been established ... The Urinary disability was less likely than not incurred in or caused by the disease or injury in service, to include exposure to herbicides in the republic of Vietnam. Veteran has a diagnosis of Bladder outlet obstruction with urethral stricture and benign prostatic hypertrophy with outflow obstruction. These diagnosed conditions with definite etiology is (sic) seen in general population and is not associated with exposure with exposure to herbicides. A nexus is not established ... The Urinary disability is less likely than not proximately due to the service-connected disability, to specifically include lungs cancer and diabetes mellitus and any medication used to treat such disabilities. The conditions of Urinary disability and Lung cancer, status post partial pneumonectomy and diabetes mellitus are not medically related. The Urinary disability is a separate entity entirely from the Lung cancer, status post partial pneumonectomy and diabetes mellitus and unrelated to it. A nexus has not been established ... The records does (sic) not show an aggravation of urinary disability beyond its natural progression by service connected condition. As to the pancreas and spleen disabilities, the examiner reported: The pancreas is less likely than not proximately due to or the result of Lung cancer, status post partial pneumonectomy (previously considered along with scar on upper torso) (previously evaluated under DC 6819). The conditions of pancreas and Lung cancer, status post partial pneumonectomy (previously considered along with scar on upper torso) (previously evaluated under DC 6819) are not medically related. The disabilities of pancreas is (sic) a separate entity entirely from the Lung cancer, status post partial pneumonectomy (previously considered along with scar on upper torso) (previously evaluated under DC 6819) and unrelated to it. A nexus has not been established ... The disabilities of pancreas and spleen is less likely than not proximately due to the service-connected disability, to specifically include lungs cancer and diabetes mellitus and any medication used to treat such disabilities. The conditions of disabilities of pancreas and spleen and status post partial pneumonectomy and diabetes mellitus are not medically related. The disabilities of pancreas and spleen is a separate entity entirely from the Lung cancer, status post partial pneumonectomy and diabetes mellitus and unrelated to it. A nexus has not been established ... There is no evidence of an aggravation of disabilities of pancreas and spleen beyond its natural progression by the service connected condition to specifically include lungs cancer and diabetes mellitus and any medication used to treat such disabilities. Unfortunately, the Board finds these opinions to be at least partially inadequate for rating purposes. Notably, the examiner provided conflicting remarks, limited rationale, and many of the opinions appear to include nearly identical remarks, despite the differences between each disability. Moreover, the examiner did not address the Veteran's service treatment records, which show that in October 1969, the Veteran was treated for reported burning on urination. Additionally, in February 1970, he was again treated for a two-week history of recurring burning on urination. Finally, the examiner did not properly opine as to direct service connection for hypertension, a pancreas disability, and a spleen disability. Considering the above, the Board finds that addendum opinions are required in this instance. The matters are REMANDED for the following action: 1. Obtain addendum opinions from the April 2021 VA examiner (or a similarly situated examiner) to determine the nature and etiology of the Veteran's claimed hypertension, urinary disability, pancreas disability, and spleen disability. The electronic claims files and all pertinent records must be made available to the examiner and the examiner must indicate in the examination report that these records have been reviewed. It should be noted that the Veteran is competent to attest to factual matters of which he had first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. (a) The VA examiner must opine whether it is at least as likely as not (50 percent or higher degree of probability) that hypertension, urinary disability, pancreas disability, and spleen disability manifested in-service or is otherwise causally or etiologically related to the Veteran's military service, to include exposure to herbicides in the Republic of Vietnam. (As to the urinary disability, service records show October 1969 treatment for reported burning on urination, and February 1970 treatment for a two-week history of recurring burning on urination.) (b) If not directly related to service, the examiner should offer an opinion as to whether it is at least as likely as not (50 percent or higher degree of probability) that any identified hypertension, urinary disability, pancreas disability, and spleen disability is caused by his service-connected disabilities. (c) That examiner should then opine whether the hypertension, urinary disability, pancreas disability, and spleen disability is aggravated (i.e., permanently worsened beyond the normal progression of that disease) by a service-connected disability. In offering any opinion, the examiner must consider the full record, to include the lay statements in support of the Veteran's claim. The examiner should also reconcile any prior report, if necessary. The rationale for any opinions offered should be provided. If the VA examiner determines that further examination is necessary in order to render the requested medical opinions, then the Veteran should be scheduled for such an examination. 2. After the development requested has been completed, the AOJ should review any report to ensure that it is in complete compliance with the directives of this remand. If the report is deficient in any manner, the AOJ must implement corrective procedures at once. Emily Tamlyn Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Miller, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.